Appointment Request Form Please fill in the form below to setup an appointment.Name* First Last Preferred Location*Please selectRainierMadisonPatient Type*New patientReturning patientReason for Appointment*General Eye ExamGeneral Eye Exam with Contact Lens FittingOtherOther Reason for AppointmentPreferred TimeMorningAfternoonAnytimePreferred Day/s Monday Tuesday Wednesday Thursday Friday Saturday Preferred Method of Communication*EmailPhone CallEmail and Phone CallInsurancePremeraVSPMedicaidOtherIf other, please specifyPhone*Email* CommentsCAPTCHANameThis field is for validation purposes and should be left unchanged.